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My cardio thinks I have microvascular angina- need some feedback!!!

Kati

Patient in training
Messages
5,497
@zzz



Thank you so much for everything you explained and I want to hear your opinion with what the doctor in the ER told me. Also, how do you know for sure that no lasting damage was done?



I have had a liter of saline a total of four other times in my life in which it all went fine. The first was when I actually had mono and was severely dehydrated so the liter must have been needed. The second and third were when I was recently in the hospital but one was over six hours and one over ten hours (so I am guessing at the slower speed, my body processed it okay?) The fourth was my first infusion at this center and it was identical to today (minus the magnesium) and done over a three hour period and I felt great for 48 hours like I had found the miracle cure. Do you know why that first one was so great, the second one was bad (but not dangerous) and the one today I guess could have killed me? Why is each one so different?

In the ER, the doctor (who was very kind and attentive) said that magnesium is usually given in an IV at one gram per hour but I got four grams in three hours which he thought was too fast for me. He said that Magnesium can cause flushing and tachycardia if too high and did a blood test on me and my level was too high. The upper limit was 2.5 and mine was 2.96 (so not crazy high but above the range.) He did not feel there was any allergic reaction and my other electrolytes (sodium, potassium, etc) were all in the low normal range. The only one that was very low and outside of the range was calcium. Does that mean anything? All my vitals were normal in the ER and he tested cardiac enzymes, etc, which were normal. At one point my BP was 110/65 so it had raised quite a bit. I asked him about the 82 on the pulse oximeter and he felt that it was probably wrong and an inaccurate reading since within 5-10 min max, it was at 100 and stayed there. Do you think this is possible?



Do mean my height and weight or my blood volume? I weigh around 110 which seems like an average weight to get one liter of saline (or is that incorrect?)



I did not have low potassium in the ER which was tested within an hour of the episode. Does this change your theory or could the potassium level have increased by then?



Can water poisoning do permanent damage? And I will not be taking the desmopressin so don't worry!



My sodium level was also not low in the ER (meaning it was inside the range) so I have the same question- does this change your theory or do you think the sodium had increased by that point?



That sounds really scary to me, like it could do a lot of damage?



Thank you although I really didn't want to go!



Do you think they missed it based on my tests and that I only had one liter of saline (which they probably assumed was okay?) If they had caught it, what should they have done differently or what can I do differently now?



That is good to know and gives me hope.



I am definitely going to continue with Midodrine, I am just done with saline and IV's for now (and maybe forever.)



Do you mean just getting enough fluids by drinking them orally? My Vitalyte just arrived which is supposed to be the exact concentration of what is needed in the blood and I am going to try it tomorrow plus all the other things I drink like coconut water, Pedialyte, etc. Do you think this is enough?



Thank you and you are so kind to spend so much time explaining all this to me. I really appreciate all you have done to help me. Do you think I should still try the Mag nebulizer once I recover from this incident (or wait since my Mag was too high on the blood test?)
Hi @Gingergrrl in my past life i was an obstetrics nurse. we gave boluses of magnesium for premature labor and indeed women would get the flushing and low BP and magnesium tends to relax the muscles quite a bit. It is very possible you had a reaction to the Mg as per your ER doctor.

You are indeed a small stature woman and it is possible that 1L is too much for you. i remember one episode in my case where I received over 1.5 L of IV, medication and hydration and in the evening, I felt particularly short of breath and found my hands to be blue while in the shower. i think I had fluid overload. (and I am not small stature)

I am so sorry about this experience and I certainly can understand how traumatic it all gets, especially when the health care professionals who are not familiar with our disease are skeptical.

best
 

zzz

Senior Member
Messages
675
Location
Oregon
Hi @Gingergrrl in my past life i was an obstetrics nurse. we gave boluses of magnesium for premature labor and indeed women would get the flushing and low BP and magnesium tends to relax the muscles quite a bit. It is very possible you had a reaction to the Mg as per your ER doctor.

I am familiar with this use of magnesium, but isn't it true that the standard dose used for the bolus is four grams, infused over 20 minutes? This would be the same dose that @Gingergrrl got, but infused nine times faster. This could certainly account for any flushing and low BP you saw in your patients. But with @Gingergrrl's infusion taking nine times as long, and considering both the high plasma levels needed to trigger these reactions and the very effective clearance of magnesium from the blood by the kidneys, it's hard to see how her magnesium levels would have gotten high enough to trigger these reactions. It's hard to say what did, though, as there are a number of scenarios that could have caused those symptoms.
You are indeed a small stature woman and it is possible that 1L is too much for you.

This is what I thought too after the second infusion, which had mild negative effects, and somewhere back in these threads are my calculations on what her likely blood volume was. It seemed to be plausible at the time. But after that disastrous third infusion, which her doctors agreed resulted in flash pulmonary edema with hypoxemia, I have a hard time believing this explanation. Why would she improve so much after the first infusion, get slightly worse after the second, and end up in the ER after the third? Her blood volume levels at the beginning of each infusion were presumably similar, as the effects of the previous infusion had worn off, and blood volume in general does not fluctuate greatly. My guess is that with all her autonomic issues, the increasing reaction to saline reflects a growing hypersensitivity reaction in her autonomic nervous system to changes in blood volume. The exact mechanism isn't clear, though.
 

Kati

Patient in training
Messages
5,497
I am familiar with this use of magnesium, but isn't it true that the standard dose used for the bolus is four grams, infused over 20 minutes? This would be the same dose that @Gingergrrl got, but infused nine times faster. This could certainly account for any flushing and low BP you saw in your patients. But with @Gingergrrl's infusion taking nine times as long, and considering both the high plasma levels needed to trigger these reactions and the very effective clearance of magnesium from the blood by the kidneys, it's hard to see how her magnesium levels would have gotten high enough to trigger these reactions. It's hard to say what did, though, as there are a number of scenarios that could have caused those symptoms.


This is what I thought too after the second infusion, which had mild negative effects, and somewhere back in these threads are my calculations on what her likely blood volume was. It seemed to be plausible at the time. But after that disastrous third infusion, which her doctors agreed resulted in flash pulmonary edema with hypoxemia, I have a hard time believing this explanation. Why would she improve so much after the first infusion, get slightly worse after the second, and end up in the ER after the third? Her blood volume levels at the beginning of each infusion were presumably similar, as the effects of the previous infusion had worn off, and blood volume in general does not fluctuate greatly. My guess is that with all her autonomic issues, the increasing reaction to saline reflects a growing hypersensitivity reaction in her autonomic nervous system to changes in blood volume. The exact mechanism isn't clear, though.
I am afraid I don't have answers for that and that for the most part we as a patient population do not have an answer for that. We are in deep fog.

I shared privately with @Gingergrrl that I have had a similar but not the same reaction after receiving 1.5L over several hours a few months ago. I was fairly short of breath in the evening, after a long day at the clinic and when I had a shower noticed that both my hands were blue. It was the weirdest thing. I believe it was due to fluid overload.

While we are lucky to have a few ME experts around the world to research and care for us, so little is known about this disease and so little funding.
 

CFS_for_19_years

Hoarder of biscuits
Messages
2,396
Location
USA
@Kati, I also thought that magnesium played a part and I stated my opinion on that earlier: http://forums.phoenixrising.me/inde...a-need-some-feedback.33098/page-3#post-520686
QUOTE="CFS_for_19_years, post: 520686, member: 376"]I think your high magnesium level played a part, not discounting the hypervolemia (no opinion there):

http://emedicine.medscape.com/article/766604-clinical
My comments are in blue
Hypermagnesemia in Emergency Medicine Clinical Presentation
Common causes of hypermagnesemia include renal failure and iatrogenic manipulations (translation: IVs and supplements). However, other diseases may result in increased magnesium; the degree of elevation determines the symptoms. Acute elevations (quick supplementation) of magnesium usually are more symptomatic than slow rises.
  • Magnesium levels of 2-4 mEq/L are associated with the following:
    • Nausea
    • Vomiting
    • Skin flushing
    • Weakness
    • Lightheadedness
  • High magnesium levels are associated with depressed levels of consciousness, respiratory depression, and cardiac arrest.
[/QUOTE]

@Gingergrrl, did you feel really loose and limber, almost like a rag doll, when you were on your feet? Those would have been signs of your muscles relaxing and too much magnesium in your system. That's how I would describe my sensations the one time when I took a lot of oral magnesium and I felt kind of loosey-goosey, not to be confused with feeling light-headed. :whistle:

Since you will be not be doing any more saline IVs, you probably won't be subjected to any of the above symptoms, but I think figuring out what happened is part of handling the stress of the event, and I think any one of us would have done the same - try to figure out what just happened.:bang-head:
 

Kati

Patient in training
Messages
5,497
@Kati, I also thought that magnesium played a part and I stated my opinion on that earlier: http://forums.phoenixrising.me/inde...a-need-some-feedback.33098/page-3#post-520686
QUOTE="CFS_for_19_years, post: 520686, member: 376"]I think your high magnesium level played a part, not discounting the hypervolemia (no opinion there):

http://emedicine.medscape.com/article/766604-clinical
My comments are in blue
Hypermagnesemia in Emergency Medicine Clinical Presentation


@CFS_for_19_years I am not discrediting you in any way, I was responding to @Gingergrrl after she pointed out to me what happened to her so I read that post today without reading the whole thread or reading any responses from other people. Please do not see this as disrespect, it's just that I am trying to not spend all of my time thinking about this damn disease.
 

Gingergrrl

Senior Member
Messages
16,171
I am about to go to sleep shortly (past midnight here!) but feel badly that this thread is causing so much debate!

Kati had asked me what happened that led me to have the echo b/c she wasn't aware that I had the saline debacle so I told her I had posted about it in this thread and happy to hear her thoughts about it as a nurse since the whole event is still such a mystery even to my doctors.

Many people have given me ideas as to what might have been the cause and I really appreciate it. Although the ER missed the opportunity to run some tests in the moment, my CFS dr thinks I had fluid overload or flash pulmonary edema that luckily resolved on its own (although I had various after effects for over a week and my body was slow to recover.)

ETA We are still not sure of the mechanism as to why I had fluid overload from one liter of saline and hoping my echo results will shed some light if it was cardiac or autonomic.

Thanks again to everyone for all the feedback during this medical crisis.
 

Kati

Patient in training
Messages
5,497
Adding on to the magnesium issue, as a chemo nurse, one of our colon cancer protocol involved infusion of 1g MG along with Calcium (forgot the dosage, I think it was 1 g also, in a 250 ml bag over 20 minutes. They would get this before their chemo and after the chemo ended and in this case I have never seen a patient having a reaction to that.

Calcium and Magnesium is used in that case to prevent peripheral neuropathy (numb fingers and toes) which comes up with the toxicity of the specific chemo called oxaliplatin. I am not entirely sure if this protocol is still followed to this day but it was 6 years ago.